To develop a Zambian context specific short and long term model for managing COVID-19 pandemic and future infectious disease outbreaks.
Lead Research Organisation:
Birmingham City University
Department Name: Research, Innovation & Enterprise
Abstract
Pandemics such as COVID-19 bring significant challenges for all health services, especially those in low-middle income countries. This trauma, emergency and critical care nursing project was developed with our established partners in Zambia, Ministry of Health, Nursing and Midwifery Council, Lusaka College of Nursing and Ndola College of Nursing, in recognition that the COVID-19 pandemic will have a short, medium and long-term impact on healthcare delivery and workforce. While funding streams may focus on the current COVID-19 pandemic itself, the likelihood of future outbreaks of COVID-19, new or known infectious diseases, cannot be discounted. Therefore, solutions must be sought to address the effects of diverting resources from an already over stretched workforce with limited resources.
In Zambia, nurses are the only professional group who are present at every stage of the patient pathway, from initial contact in a rural health clinic or emergency and trauma services through inpatient services to discharge and rehabilitation. Individually they have more patient contact than all other professional groups combined. These nurses need to have increased capacity in leadership, management and clinical decision-making. These attributes, essential to prevent healthcare systems becoming overwhelmed enable nurses to identify and respond appropriately to the rapidly changing health needs that arise during outbreaks of infectious diseases and pandemics. They include the ability to develop and implement strategies for containing infected cohorts and preventing the disease spreading.
Our shared needs assessment early in the pandemic. identified the urgent need to up-skill their healthcare workers for what is likely to be rapidly increasing need. These will enable them to be both proactive and reactive in their responses to the COVID-19 pandemic and other infectious diseases. This project will be conducted in three phases.
Phase 1: Communities engagement examines how the 73 tribes, with their own language, cultural beliefs and traditions engage with the limited community healthcare services. The nurses live alongside and with the communities they serve, and have a very wide remit, being expected to treat whoever seeks their assistance. This includes communicable and non-communicable diseases (for all age groups), public health and prevention. Consequently, the COVID-19, with its rapid onset and high, unprecedented incidence inevitably impacts adversely on services that the community relies on.
Phase 2: Documentary Data Analysis will be used to analyse, interpret and national documentation, health statistics and information, to complete a gap analysis regarding COVID-19. Much of the information, guidance, education and training that the MoH have been able to access was developed in High-Income Countries, and may not be apposite for the Zambian context. Therefore, this project will identify strategies that can build on (and not adversely impact on), current Zambian health systems and structures.
Phase 3: Development of processes for practice and enhanced nursing response to COVID-19, combining results from phases one and two to develop educational and clinical processes and procedures for practice; and make recommendations for policy for dealing with COVID-19. This includes planning for a possible second wave, and future infectious disease outbreaks.
Deliverables from this research include recommendations for national and international policy makers. A national curriculum and competency assessment document for Bachelor of Science in Trauma and Emergency Nursing and critical care specialist practice. The sharing of outputs via webinars and virtual conference/actual conferences, and peer-reviewed journal papers. It will facilitate knowledge exchange and transfer between healthcare professionals Zambia and UK and support the establishment of an international community of practitioners with expertise in COVID-19 management.
In Zambia, nurses are the only professional group who are present at every stage of the patient pathway, from initial contact in a rural health clinic or emergency and trauma services through inpatient services to discharge and rehabilitation. Individually they have more patient contact than all other professional groups combined. These nurses need to have increased capacity in leadership, management and clinical decision-making. These attributes, essential to prevent healthcare systems becoming overwhelmed enable nurses to identify and respond appropriately to the rapidly changing health needs that arise during outbreaks of infectious diseases and pandemics. They include the ability to develop and implement strategies for containing infected cohorts and preventing the disease spreading.
Our shared needs assessment early in the pandemic. identified the urgent need to up-skill their healthcare workers for what is likely to be rapidly increasing need. These will enable them to be both proactive and reactive in their responses to the COVID-19 pandemic and other infectious diseases. This project will be conducted in three phases.
Phase 1: Communities engagement examines how the 73 tribes, with their own language, cultural beliefs and traditions engage with the limited community healthcare services. The nurses live alongside and with the communities they serve, and have a very wide remit, being expected to treat whoever seeks their assistance. This includes communicable and non-communicable diseases (for all age groups), public health and prevention. Consequently, the COVID-19, with its rapid onset and high, unprecedented incidence inevitably impacts adversely on services that the community relies on.
Phase 2: Documentary Data Analysis will be used to analyse, interpret and national documentation, health statistics and information, to complete a gap analysis regarding COVID-19. Much of the information, guidance, education and training that the MoH have been able to access was developed in High-Income Countries, and may not be apposite for the Zambian context. Therefore, this project will identify strategies that can build on (and not adversely impact on), current Zambian health systems and structures.
Phase 3: Development of processes for practice and enhanced nursing response to COVID-19, combining results from phases one and two to develop educational and clinical processes and procedures for practice; and make recommendations for policy for dealing with COVID-19. This includes planning for a possible second wave, and future infectious disease outbreaks.
Deliverables from this research include recommendations for national and international policy makers. A national curriculum and competency assessment document for Bachelor of Science in Trauma and Emergency Nursing and critical care specialist practice. The sharing of outputs via webinars and virtual conference/actual conferences, and peer-reviewed journal papers. It will facilitate knowledge exchange and transfer between healthcare professionals Zambia and UK and support the establishment of an international community of practitioners with expertise in COVID-19 management.
Publications
Aongola AMM
(2024)
Capacity strengthening for clinical nutrition in Zambia: a roadmap for success in tackling undernutrition.
in British journal of nursing (Mark Allen Publishing)
Banda P
(2024)
Family-witnessed resuscitation in the emergency department in a low-income country.
in British journal of nursing (Mark Allen Publishing)
Carter
(2021)
Covid-19: A Critical Care Textbook
Carter C
(2021)
The 'sleeping elephant': The role of mentorship of critical care nurses in Zambia.
in International nursing review
Carter C
(2023)
Evaluation of an international health partnership to capacity build emergency, trauma and critical care nurse education and practice in Zambia: An experience from the field.
in International nursing review
Carter C
(2020)
COVID-19 disease: perspectives in low- and middle-income countries
in Clinics in Integrated Care
Carter C
(2021)
Covid-19 1 year on: The challenge for low-middle income countries.
in Nursing in critical care
Carter C
(2022)
Review of enteral nutrition practices in critically ill adults in resource-limited environments.
in BMJ military health
Notter J
(2022)
Handing on the baton: developing early career nurse leaders.
in British journal of nursing (Mark Allen Publishing)
Notter J
(2021)
What lessons can we take from reverse innovation?
in British journal of nursing (Mark Allen Publishing)
| Description | The outputs from this award can be divided into short, medium and long term. Short term Increased awareness and understanding of the level of knowledge of Covid-19 in qualified and student nurses in Zambia, including personal safety procedures and safeguarding of patients and families. Covid 19 is still present in Zambia, thus the training programme and learning materials developed during the project are still relevant and have been integrated into ongoing education and training programmes A national nurse education and training programme on coping with Covid-19 developed includes infection prevention, identification and care modalities such as the prone position and oxygen therapy, piloted and evaluated. although the project completed last year, this is still being disseminated through the medium of individuals trained during the project continuing to contribute to national training programmes. medium term The data gained has been used to identify key issues in nurse education and practice and to future proof the emergency and trauma nursing and critical nursing curricula. Emergency and trauma nurses are the first contact for most patients with suspected or confirmed Covid-19, and in the principles of infection preventiomn and control. Also, as one of the few specialist groups of nurses they therefore carry increased responsibility for the implementation and management of healthcare services, particularly in rural areas where there are too few doctors. Their education and training programmes have been internationally peer reviewed, in line with WHO, international recommendations for emergency and trauma nursing and Zambian regulations. Following the review, the advanced diploma was revalidated and a new BSc programme in Emergency and trauma nursing written that is now due to enrol its first cphortmof students Both programmes contain the Covid-19 materials, nhanced infection prevention and control strategies and the template developed in the project that will enable information to be adapted for use in any future infectious disease outbreaks The other crucial group of nurses are critical care, and the pandemic has highlighted the importance of their knowledge and expertise. This project has also revised the BSc in Critical Care Nursing in line with Zambian and WHO regulations, with the result that it too now includes the inclusion of Covid-19 and enhanced strategies for infection prevention and control 15 critical and emergency and trauma nurse specialists/lecturers have completed clinical research training at postgraduate level, and relevant ( to this project) clinical research is now in progress in infection prevention, surgical procedures for Covid-19 patients, patient dignity, and triage in emergency and trauma nursing, in additional to several articles, a critical care Covid-19 textbook was completed and published, it is in use internationally with 200 copies supplied by the publisher for distribution across Zambia, and the book has been translated into Spanish for wider international use. as it is now accpeted that Covid 19 is becoming endemic, the content will be of use for years to come |
| Exploitation Route | During the process of transforming both the Emergency and Trauma, and Critical Care Nursing curricula to include Covid-19 / infectious disease prevention a template was developed which can be adapted for other nursing and allied health care professional programmes. It has been designed to facilitate the addition of materials for education and training competences for any future infectious disease outbreaks (e.g. resurgence of Cholera, Ebola etc). It is anticipated that the template can also be adapted for use with non-communicable diseases as they too are causing a rising burden of disease. This will facilitate a rapid nursing response to changing needs arising from communicable and non-communicable diseases. through the training a cohort of senior nurse specialist and lecturers from critical care and emergency and trauma nursing in clinical research, dissemination of their new knowledge has enabled a wider group of nurses to gain insight into and understanding of research, amnd now nurses are beginning to develop their own evidence based practice and to initiate nursing research |
| Sectors | Communities and Social Services/Policy Education Healthcare Government Democracy and Justice Other |
| Description | The study was completed in 2022, shortly after this, as a result of the impact of the pandemic Zambia was reclassified as an LIC, making sustainable outputs from the project even more important in terms of service delivery. The activities were carried out based on the logical framework developed at the start of the study, and were used to support short medium and long term responses to the Covid-19 pandemic. Training in the nursing management of Covid-19 took place across the country, with qualified and student nurses demonstrating an increased awareness of Covid-19, how to protect themselves, the patients and their communities. A bonus activity was that during the initial training activities, physicians and other healthcare professionals also made contact with the project team and requested education and training in managing services and care in a pandemic. Of particular concern to them was recognition of Covid-19, treatment modalities and oxygen therapy as the pandemic had led to increased access to oxygen, but additional training had been limited. All requests were accepted, with feedback very positive. In the final phase of the study which was designed to cascade training across the country, the need for a training programme was accepted by the Ministry of health who absorbed key training activities into their own programme, and took over dissemination on a much wider basis than had been included in the project. this gives sustainability to this key activity as it will now be part of their rolling training programme. In addition following one training programme an action research project to support major changes in clinical practice was set up with one general hospital, this is still in progress, but will result in major chancres in the emergency, trauma and critical care services offered The study also included the review and revalidation of the advanced diploma in emergency and trauma nursing and the development of a new specialist BSc. These programmes have been harmonised with the BSc in Critical Care ( and its advanced diploma) and all contain Covid-19 materials, are in the forefront of specialist nurse education and training for Zambia, with key elements of the programme enhancing and extending specialist nursing. The revalidated advanced diploma in emergency, and trauma nursing is running with one cohort per year, and the first cohort of the new Zambian BSc commence 2023. The first cohort of students has now completed this higher level of study and are back in practice, and are now working across the country enhancing emergency care. the programme is now well established with annual cohorts of over 20 students. The development of the enteral feeding research project towards the end of the project, has been very successful. The initial results demonstrated the importance of good nutrition in preventing complications and improving recovery. since completion of the project, the programme has spread to other hospitals in the capital, and the Ministry of Health are now interested in developing this approach for use across the nation. In addition although designed for adult patients, this research activity is also being expanded to include paediatric patients. In 2023 and 2024, the enteral feeding research data continued to demonstrate the effectiveness of the regimen , with the result that other hospitals who originally wanted to use the regimen now want to replicate the research study. For this the original team reconvened and developed a specific training programme for members of the multi-disciplinary team with limited research knowledge and expertise. This has been completed by one hospital who are now commencing the research. The added bonus of this is that in the participants now have enhanced research skills as well as the requisite knowledge of nutrition and enteral feeding. A second hospital has completed the training. Philanthropic donations have enabled this research project to continue and to consider expansion, with requests having been made to extend it to include the children's hospital which is part of the tertiary referral group of hospital in Lusaka. the findings from this research have been presented at conferences and an article is now in preparation For the UK, this project provided an opportunity for nurses (clinical, education and research) to work with participants in an LMIC/LIC, gaining insight and understanding of the context and delivery of different health systems and the impact of coping with a pandemic with very limited resources. Overall, a two branched approach was used. In total with some support from HEE England over the lifetime of the project 6 UK senior clinical nurses/lecturers will have participated in activities in Zambia, and a further 7 UK health professionals, including a nutritionist, a medical anthropologist, the deputy chief nurse for England and other clinical nurse specialists have given virtual lectures.. The study tour to the UK for the lead Zambian investigator at the start of the project was advantageous, as this enabled her to share directly her knowledge and experiences with UK peers through clinical visits and seminars. The closure of borders prevented travel by other participants, in the lifetime of the project, but approval was gained to change the study tour to include another country in Sub-Saharan Africa, with exchange study tours then taking place with Malawi. this proved beneficial to all parties, it facilitated knowledge exchange and dissemination of the project activities and proved to be the starting point for a new health partnership which has included students being sent from Malawi to study critical care nursing in Zambia. Linked to this project outcomes, additional funding was obtained for 4 African MSc students to undertake short study tours to the UK to visit NHS Trusts and explore care and expertise available in the UK. Also to meet UK members of the virtual community of practice established during the lifetime of the project, as this facilitates virtual knowledge exchange and transfer. A bonus output in 2023 was a direct result of the oxygen training given during Covid-19. A request was made for the team to carry out a national training programme in oxygen therapy and safety. 76 nurses from across Zambia completed a train the trainer programme. they have now cascaded the training to over 700 nurses. a formal evaluation of the effectiveness and sustainability of the training programme is now underway. The formal evaluation has been completed and the report accepted by the funders. The evaluation revealed that the trainers have retained the role of oxygen champions, and are recognised in their hospitals as oxygen trainers for nurses, medial students and in some instances physicians. they also play the role of monitoring and checking oxygen delivery, responding for requests for advice and guidance as needed. publication regarding this project is now in progress. |
| First Year Of Impact | 2022 |
| Sector | Agriculture, Food and Drink,Communities and Social Services/Policy,Education,Healthcare,Other |
| Impact Types | Cultural Societal Policy & public services |
| Description | Changes in nursing protocols for practice across the country, improving patient safety when oxygen therapy is needed |
| Geographic Reach | Africa |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | the training of over 700 nurses will impact on the care given to thousands of patients needing oxygen therapy. evidence is being collected through the current evaluation of the effectiveness and sustainability of the training |
| Description | Clinical research training for postgraduate emergency, trama and critical care nurses |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | Critical Care Nurses Association of Malawi |
| Geographic Reach | Africa |
| Policy Influence Type | Contribution to new or improved professional practice |
| Description | Formation of Critical Care Nurses Association for Zambia (CCNAZ) |
| Geographic Reach | National |
| Policy Influence Type | Contribution to new or improved professional practice |
| Impact | CCNAZ has been accepted by the Ministry of Health and healthcare professional regulators (Nursing and Midwifery Council and Health Care Professions Council) as a professional organisation in its own right and will be involved in all future discussions of the critical care nursing profession. |
| Description | Safeguarding patients |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Training package used to increase the ability of pre and post registration nurses to identify, assess and initiate interventions for suspected or confirmed Covid-19 patients. This has lead to earlier treatment with the aim of minimising complications. This was seen as important as until this training was developed and delivered students were being redeployed to Covid-19 clinical areas to support registered staff. |
| Description | development of a low cost highly sustainable enteral feeding regimen for critically ill patients |
| Geographic Reach | National |
| Policy Influence Type | Contribution to new or improved professional practice |
| Description | national Covid-19 training programme |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | the training programme is still being disseminated as the project has not yet completed. However, initial feedback indicates that the following training the changes in practice have been effective, with patients being treated using the competences taught in both general care and factors such as oxygen administration. the focus groups held with nurses include quotes where they confiem that the new practices they had learned had a positive output on the care given |
| Description | request to develop new specialist education cardiac care |
| Geographic Reach | Africa |
| Policy Influence Type | Contribution to new or improved professional practice |
| Description | An Evaluation and Impact of the LINET Critical Care Bed in an emergency department and intensive care unit in a low-resource setting |
| Amount | £26,000 (GBP) |
| Funding ID | N/A |
| Organisation | Linet |
| Sector | Private |
| Country | Czech Republic |
| Start | 08/2022 |
| End | 08/2023 |
| Description | Global Capacity Building Programme |
| Amount | £50,000 (GBP) |
| Organisation | Tropical Health & Education Trust (THET) |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 01/2024 |
| End | 06/2025 |
| Description | Global Placement Bursaries for Health Partnerships (GPBHP) |
| Amount | £5,000 (GBP) |
| Funding ID | GPBHP 1.11 |
| Organisation | NHS England |
| Department | Health Education England |
| Sector | Public |
| Country | United Kingdom |
| Start | 07/2022 |
| End | 02/2023 |
| Description | Nursing Now Challenge Fellowship |
| Amount | £8,000 (GBP) |
| Funding ID | NNCF0.7 |
| Organisation | Burdett Trust for Nursing |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 01/2022 |
| End | 03/2023 |
| Description | To develop sustainable, context specific Zambian cardiac care nurse education and training programmes. |
| Amount | £46,550 (GBP) |
| Organisation | Burdett Trust for Nursing |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 07/2024 |
| End | 11/2025 |
| Title | Development of a low cost highly sustainabile enteral feeding regimen for crticial care patients |
| Description | The design, implementation and evaluation of the use of a low-cost, highly sustainable enteral nutrition (EN) protocol for critically ill patients admitted to the intensive care unit at the University Teaching Hospital Lusaka. Good nutrition in critical care patients not only to promotes health and wellbeing, but also aids recovery from trauma, surgery or disease and helps prevent complications from critical illness. Enteral nutrition (EN) is the feeding of patients using a liquid feed via a tube (normally a nasogastric tube) inserted either into the stomach or post-pyloric and is the preferred route for critically ill patients when the oral route is not possible. Although studies identifying whether early enteral feeding reduces length of critical care stay, infection rates and mortality are variable it is accepted that early EN should be initiated in patients who are expected to be without oral intake within 3 days of admission to critical care. Critical care nutrition is a complex area of practice and in resource limited environments there are added challenges due to the limited availability of commercial feeds. Current practice on the MICU includes routine insertion of a naso-gastric tube (NGT) or orogastric tube (OGT) and early initiation of EN by Critical Care Nurses (unless contra-indicated). However, prior to this project there had been limited nutrition assessment and monitoring, nutritionist input, and the nutritional value of the current hospital enteral feed was unknown. It was also a cause for concern, that in ICU settings there is a high risk for NGT misplacement or migration. In consequence, there was urgent need to address NGT safety and EN provision to critically ill patient. Therefore, this project built on current good practice, to extend and enhance nursing practice, and provide evidence to increase unserstanding of this complete area of practice. The project commenced in February 2022 and includes the following aspects: • Development of an Enteral Nutrition training package. • Nasogastric safety project • Introduction of Anthropometric measurements. • Introduction of the Critical Care Lusaka Birmingham (CCLUB) enteral nutrition for adult patients. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2024 |
| Provided To Others? | Yes |
| Impact | The inital pilot was successfully completed and has beeen extended, Currently over 100 patients have been enrolled onto the regimen developed. and the Initial results revealed a signficiant reduction in weight loss in patients and the development of pressure ulcers Findings were shared with senior management and the Ministry of Health and following this on request from the Ministry of Health a training programme for nutitionists has been developed Two other hospitials have commended the progamme with support frm the BCU team, and the national chidren's hospital is working with the team to develop and implement a paediatric regimen The Minsitry of Health are now seeking ways to find funding to extend the project across the country and to open the regimen to a wider group of patients |
| Title | National E-survey regarding nursing knowledge of Covid-19 |
| Description | Ethics approval was obtained from both Zambia and UK. Following this a questionnaire was developed, piloted and evaluated. The questionnaire was designed with a unique URL to protect confidentiality, however, due to limited computer access, low band width and to reduce staff using shared communal computers (which poses an infection risk). The e-survey had to be designed for completion by the use of a smart phone. This approach has been successfully used by the research team twice before, but does bring challenges in terms of formatting and uploading results. Nevertheless, it is an effective approach as the majority of nurses have phones adequate for the survey planned. Initial findings revealed the majority of respondents were not confident in the 'donning' and 'doffing' of personal protective equipment (PPE), and had had little formal input into identifying and nursing patients with Covid-19. Even in the most rural areas, nurses had received information from government circulars and training, but were requesting more. Not all responses have been received as yet, as the return time is still open. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2020 |
| Provided To Others? | No |
| Impact | The findings are already feeding into the plans for the rural workshops which will take place later in 2021. Also, last year funding was achieved to develop a local online training package for Covid-19, this will be amended and upadated in the light of new infomration regarding the treatment of Covid-19 and the survey findings. In turn, this will then be nationally rolled out to participating Colleges of Nursing with a remit for both undergraduate and continuous professional development. |
| Title | practice evaluation tool for oxygen therapy and safety |
| Description | the research tool developed has been specifically designed to measure the competence of nurses who have completed the training programme. assessment is in two parts one based on OSCEs where actual assessed nd the second part is designed to assess the knowledge base |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2023 |
| Provided To Others? | Yes |
| Impact | evaluation still in progress. initial feedback positive changes in practice and competence |
| Description | Extending enteral nutrition in critical care |
| Organisation | University Teaching Hospital |
| Country | Zambia |
| Sector | Hospitals |
| PI Contribution | The collaboration arose as a result of the enteral feeding research started during the original project. The research generated in this field has had positive outputs and the hospital requested technical advice and support to continue the programme beyond the lifetime of the project. To facilitate the delivery of this an MoU was completed, research training given and the ongoing delivery of the research commenced, with BCU providing further and ongoing technical expertise and quality assurance to the overall research. The collaboration extended to to two other hospials and is now extending to the tertiary referral Children's Hospital. |
| Collaborator Contribution | The critical care nurses were identified as appropriate to lead the implementation and evaluation of the effectiveness of the enteral feeding research programme. The research training and guidance has enabled the partner team to develop the research skills needed to develop the specialised enteral feeds, collect and record the data, then analyse and report the datasets. All data is to be shared with the BCU team to help and currently articles are in preparation to disseminate the outcomes. This research was designed to deliver a low-cost highly sustainable feed for the critically ill, and therefore if needed post discharge, the feed itself can be continued by families. |
| Impact | The partnership is multi-disciplinary, involving physicians, nurses and nutritionists. Also one student has completed an MSc dissertation research study on one aspect of this research, this is now being disseminated locally, nationally and internationally. Following dissemnination of the original research, a series of philanthropic donations were made to enable this research to continue to give longitudinal results which will be dissemination this year. Current outputs include a publication in BMJ Military Health in2022, conference presentations, research reports and as there arenow three years of results further dissemination via journal articles is now planned for this year |
| Start Year | 2021 |
| Title | Infusing Public Health into acute care curricula |
| Description | Principles of public health education and training being introduced into emergency and trauma nursing curricula. To enable nurses to understand their role in the prevention and spread of Covid-19 and ultimately control of the pandemic. |
| Type | Health and Social Care Services |
| Current Stage Of Development | Initial development |
| Year Development Stage Completed | 2021 |
| Development Status | Under active development/distribution |
| Impact | A change in the nursing curricula and also a change in teaching methods as the programme developed in blended learning. Traditionally, teaching has been face-to-face, not possible due to the pandemic, this is one way in which nurses can access education. Again, tailored to be accessed via a smart mobile phone. |
| Title | Patient dignity |
| Description | early project activities revealed that patient dignity and privacy was an issue. it had been accepted that patients in intensive care would be naked with only a sheet to cover them. this is distressing for conscious patients families and relatives. Following a training programme it was accepted that safeguarding patients crossed all areas of care and that dignity, privacy and respect should be afforded to all patients and their families. the study was designed to pilot the use of specially designed patient gowns in the main intensive care unit. these resemble patient gowns used in the UK and have been designed for ease of access for the extensive nursing interventions needed in ICU. The materials for the gowns was locally sourced, employing local seamstresses and funding through a project donation. the need for patient dignity and respect has been included on nursing documentation and includes information and support for families. the study is now in progress. Initial findings will we available by the completion of the studt |
| Type | Therapeutic Intervention - Complementary |
| Current Stage Of Development | Small-scale adoption |
| Year Development Stage Completed | 2022 |
| Development Status | Under active development/distribution |
| Impact | it is too early to state outputs, but the introduction of the study has been welcomes by medical and nursing staff and families |
| Title | Patient dignity |
| Description | early project activities revealed that patient dignity and privacy was an issue. it had been accepted that patients in intensive care would be naked with only a sheet to cover them. this is distressing for conscious patients families and relatives. Following a training programme it was accepted that safeguarding patients crossed all areas of care and that dignity, privacy and respect should be afforded to all patients and their families. the study was designed to pilot the use of specially designed patient gowns in the main intensive care unit. these resemble patient gowns used in the UK and have been designed for ease of access for the extensive nursing interventions needed in ICU. The materials for the gowns was locally sourced, employing local seamstresses and funding through a project donation. the need for patient dignity and respect has been included on nursing documentation and includes information and support for families. the study is now in progress. Initial findings will we available by the completion of the studt |
| Type | Therapeutic Intervention - Complementary |
| Current Stage Of Development | Small-scale adoption |
| Year Development Stage Completed | 2022 |
| Development Status | Under active development/distribution |
| Impact | it is too early to state outputs, but the introduction of the study has been welcomes by medical and nursing staff and families |
| Title | the development of enteral feeding |
| Description | As a resource limited country Zambia cannot afford to purchase commercial enteral feeding products, therefore currently the feed given lacks essential vitamins, minerals and carbohydrate levels. this is a clinical trial to develop, pilot and evaluate the development of an enteral feed from locally sourced materials. the project is being trialled in tow placed. the main intensive care unit in University Teaching Hospitals (Adult) Zambia, and the cancer hospital adjacent to UTH. The project is supported by the lead physician from the main intensive care unit, and nutritionists from a London teaching hospital. All necessary approvals have been gained, appropriate equipment is now available, and the project is about to start |
| Type | Preventative Intervention - Nutrition and Chemoprevention |
| Current Stage Of Development | Early clinical assessment |
| Year Development Stage Completed | 2021 |
| Development Status | Under active development/distribution |
| Impact | this clinical research project will develop the first locally sourced enteral feeding product for use for patients, initially in two places. Firstly the main intensive care unit in UTH, and once formally evaluated across the hospital. secondly, in the cancer hospital at UTH. The project protocols have been developed with expert assistance from both Zambian and UK dieticians The project is now underway, and has been well received in both centres. initial findings will be available by the end of the project, |
| Title | launch of Clinibee in Zambia |
| Description | Clinibee is an App hosted on Microsoft Azure in two centres in the UK. NHS UK pays to subscribe as it consists of a tailor made 'libraries' of clinical data that can be accessed on a phone enabling the nurses and physicians to access information while still in practice.. This means organisations can rapidly respond to evolving clinical practice, and maintain governance oversights as information is rapidly distributed at the bedside. Using the platform reduces administrative burdens, supports clinical collaboration, and helps to standardise clinical practice. this in turn supports quality care delivery. the App was not in use in Zambia, but as nurses may have access to smart phones but not necessarily laptops, Clinibee offered to allow the project team to launch it free of charge in Zambia. a project team was set up, to study and create the templates needed for and materials created and uploaded. |
| Type Of Technology | Webtool/Application |
| Year Produced | 2021 |
| Impact | This is the first App based product for specialist nursing in critical care and emergency and trauma nursing to be launched in Zambia. the core team have leaned additional technical skills as they developed the materials for the App. Specialist nurses from across the country Nurses have registered, and can now easily access up to date information specifically designed for use in the Zambian health system. An initial evaluation shows very positive feedback, and the programme is now being extended to Malawi. access is via email not URL |
| Description | Emergency and trauma major incident training |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | This was a regional training for am major incident in emergency and trauma. the project team from the UK and Lusaka College of Nursing and Midwifery were core members of the incident which included physicians paramedic, police and fire services. the training lasted a full week, starting with the theoretical components and culminating in a staged city wide incident. All participants attended the full programme completing both education and clinical practice sessions to prepare them for a major incident, with emergency preparedness across the differing participating services a core element. Several possible causes were studied, including natural disasters, infectious disease outbreaks such as cholera, and the current Covid-19 pandemic sessions focused on identification, immediate treatment, and prevention of spread. coping with major road traffic accidents, fires and major industrial accidents. key professional practitioners were assessed on their performance. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Faculty development in Zambia |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | 3 senior membrs of the leading Zambian University attended a 4 weeks study exchange with Birmingham City Unniversity with clinical placements in local (West Mdlands) NHS acute trusts to gaine expertise in Emergency, trauma and critical care nursing at MSc level. 2 members of the team have gone on to complete a postgraduate certificate in emergency trauma and critical care to enhance the level of education and training they can delivr to their students thriugh individual and faculty eucation and training |
| Year(s) Of Engagement Activity | 2024 |
| Description | Internationally recognised research education and training |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The project activities revealed that nurse leaders and educators had limited expertise in clinical research and use of research. It was therefore decided that for sustainability a small cohort (15) nurse specialists /leaders from emergency and trauma nursing, critical nursing and specialist nurse education and training would undertake a formal, accredited research training programme. Participants were from the three leading colleges of nursing that deliver specialist nurse Lusaka College of Nursing and Midwifery, Ndola College of Nursing and Livingstone College of Nursing. also from University Hospitals (Adult) Lusaka. This programme includes Covid-19 specific issues, it completes in March 22 and the group will then be in a position to disseminate their knowledge and expertise, both in practice and in nurse education and training. there are already plans for the start of nursing research in specialist practice, and requests for members of this for this group to share and disseminate their expertise. |
| Year(s) Of Engagement Activity | 2021,2022 |
| Description | Launch of the Critical Care Nurses Association of Malawi |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | The project team has continued to work with Malawi and support their development of emergency and critical care nursing. In recognition of the role played by the project team, the Minister of Health in Malawi, invited the team to co-launch the Critical Care Nurses Association of Malawi. The launch was attended by international partners from Zambia and other countries within the region. |
| Year(s) Of Engagement Activity | 2024 |
| Description | National Trauma and Major Incident Training Exercise |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | As a compulsory component of the Advanced Diploma and BSc in Emergency & Trauma and Critical Care, all students have to complete a week long trauma training package, which culminates in a pre-hospital major incident exercise. This event is now its third year and will continue annually in each of the Colleges of Nursing (x3) as it has been incorporated into the above programme curricula. |
| Year(s) Of Engagement Activity | 2024 |
| Description | National training for nurses in oxygen therapy and oxygen safety |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | 76 clinically practicing nurses were trained as train the trainers for oxygen therapy and oxygen safety. These nurses completed the training and then on their return to their own hospital cascaded the training locally. As a result over 700 nurses have now been trained and are able to practice safe oxygen therapy. Feedback has been very positive with regard to practice, and a formal evaluation of the effectiveness and sustainability of the training is now in progress |
| Year(s) Of Engagement Activity | 2023 |
| Description | Nurse leadership training for \main intensive care in UTH |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | the result of the pandemic was that nurses from the main intensive care unit were deployed to led and support nurses across the main hospital, offering specialist input to support care. this left the main ICU with few qualified staff who had had any leadership in nursing training. although not part of the original project addressing the senior nurses concerns was part of the Covid-i9 response A series of interactive leadership workshops were held to enable these nurses to accept and cope with the position in which they found themselves, these helped them to develop the expertise and skills to guide, mentor and lead their peers, and to improve their clinical decision making process |
| Year(s) Of Engagement Activity | 2021,2022 |
| Description | Policy makers meetings |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Prior to the project launch, two policy maker meetings were held with the Ministry of Health and the nursing regulator (Nursing and Midwifery Council of Zambia, formerly the General Nursing Council). The MoH identified outputs from this project will contribute to revised National Strategic Health Plan that is currently developed. The recent repeal of the Nurses Act, has changed the NMCZ mandate to include specialist nursing practice. Therefore, the outputs from this project will contribute to the NMCZ as they formalise specialist nursing cadres. |
| Year(s) Of Engagement Activity | 2020 |
| Description | Post Graduate Student Research Workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | These post-graduate students are all in the front line of coping with Covid-19 either critical care or emergency and trauma nursing. As a low-middle income country, Zambia has few doctors in these specialities and nurses carry the additional responsibilities in carrying out nursing care. This is the first workshop offering participants the opportunity to share concerns and anxiety and to gain increase knowledge of the implications of Covid-19, this includes disease progression, complications and outcomes. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Rehabilitation following critical care illness |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | As part of an ongoing collaboration with partners and the Ministry of Health, a rehabilitation following critical illness project was established. This received considerable interest locally and nationally, resulting in a television documentary featuring the team and an invited keynote presentation at the inaugural community health conference in Zambia. This has led ongoing engagement with a wider audience with NGOs, such as PATH and On Call Africa and international organisations such as UNICEF. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Rsearch Workshops |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | A series of national research workshops have been conducted with key professionals and policy makers. Representation was from all provinces to review and identify the way forward for the Covid-19 response in key acute sector areas of nursing practice, with a strong emphasis on trauma and emergency nursing. This was deemed crucial as these nurses are the first point of contact for the community with Covid-19 symptoms, it has to be noted that in the more rural areas, there may not be a doctor present at all times, which raises the responsibility of these nurses and the importance of enhanced education and training in infection prevention and coping with the pandemic. By completion of the fourth workshop consensus had been reached regarding the education and training needed for post-registration nurses moving towards Bachelor's level education. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Rural Covid-19 training workshops for nurses |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Additional engagement has arisen directly as a result of successful project activities. Over 60% of the Zambian population live in rural settings, with limited access to major health care facilities. The limited staff numbers and major distances make it difficult for the limited health care services, to release staff for training programmes, particularly as In many of the rural setting, nurses are the main workforce, and in some instances where there is no resident physician they are the lead care providers. The programme designed a training programme with a local train the trainer team. and final workshops are in progress. However, the programme has been very received well, and as a result the Ministry of Health has accepted the programme, incorporating it into their plans and funding a second team to extend its reach to other healthcare professionals. Thus, there is sustainability of the programme beyond the lifetime of the project. |
| Year(s) Of Engagement Activity | 2021,2022 |
| Description | Stakeholders Launch Meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The strategic stakeholders meeting provided a forum in which key stakeholders were able to explore the proposals and discuss the outcomes. Representation from the Ministry of Health, Nursing and Midwifery Council of Zambia (formerly the General Nursing Council of Zambia), Zambian Union of Nursing Organisations (professional body and trade union), universities, Colleges of Nursing and senior nurses from clinical practice. Stakeholders developed the questionnaire, identifying key concerns and issues. |
| Year(s) Of Engagement Activity | 2020 |
| Description | covid-19 education and training for hospitals |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | this Covid-19 training programme was delivered in a shanty town hospital. Un urgent request was made to the main project team to offer education and training on how to cope with Covid-18. the hospital had until just before the pandemic been a local clinic and had only just been upgraded to a hospital. however, this change had not been accompanied by training or clinical support. the hospital was at that time overwhelmed with Covid-19 patients, and without any critical care or high dependency facilities were struggling to cope. Initial training was delivered the day after the request to nurses, physicians and other health care professionals who needed guidance in all aspects of care, including oxygen therapy, for these unprecedented numbers of patients. This led to a series of additional training workshops to cover the more technical and complex care issues. Also to the short term secondment of specialist critical care and emergency and trauma nurses to provide clinical guidance and training to the bedside nursing staff. the links have been continued and have strengthened supporting the development of an action research project as the hospital works to change and improve emergency and trauma and high dependency care |
| Year(s) Of Engagement Activity | 2021,2022 |